PROJECT SUMMARY: Although the association between educational attainment and physical health outcomes?including leading causes of mortality like cardiovascular disease?is well known to be large in magnitude, enduring over the life course, and invariant across sex, race, and ethnicity, there are few existing studies that are capable of prospectively disambiguating aspects of early education that are most predictive of physical health in adulthood and thus most productively targeted in intervention and prevention efforts. Likewise, few studies of the school context are also well positioned to incorporate in the same sample correlated aspects of risk in children's early home environments that might initiate a developmental cascade resulting in poorer physical health outcomes in adulthood via childhood educational experiences. To address these limitations, the current application is designed to leverage the landmark NICHD Study of Early Child Care and Youth Development (SECCYD; 1991- 2006), a large-scale, prospective study of children thus far followed prospectively from birth, to evaluate a life course model whereby early life adversity is hypothesized to confer risk for intermediate health outcomes relevant to health risk partially through correlated variation in both a) academic achievement and attainment and b) educational experiences during childhood (e.g., the quality of educational experiences, both interpersonal and instructional in nature). Building on an NHLBI-sponsored follow-up of the female sub-sample of the SECCYD (pending R01HL130103, PI: Bleil, to begin 7/1/16), funding for the current application will enable identical assessments in the male participants including relevant parameters of health/disease risk. This effort will produce a high powered study of 750 total SECCYD participants (~50% male; ages 25-30 over study period), assuming 80% return of 940 participants. The follow-up visit will involve assessments in domains of cardio-metabolic and inflammation known to predict long-term risk for disease derived from a physical examination, blood draw, and comprehensive medical history/health behavior evaluation. These new measures generated from the current study will be examined in relation to existing, state-of-the-art assessments of early life environments and educational achievement/experiences acquired as a part of the original SECCYD data collection on both genders. Early life adversity will be characterized using measures of childhood SES, infant-mother attachment, maternal sensitivity, father absence, negative life events, and maltreatment. Academic achievement will be assessed using teacher-reported and objective assessments of academic skills whereas educational experiences will be studied using classroom observations along with questionnaire assessments of the quality of teacher-child relationships. In sum, the proposed study reflects a unique, time-sensitive opportunity to examine longitudinally the extent to which academic achievement and/or the quality of childhood educational experiences uniquely predict health risk in adulthood, as well as to explore childhood variables that moderate, and adult behavioral/lifestyle variables that mediate these prospective associations.